The EXIT (ex-utero intrapartum treatment) procedure - from the paediatric ENT perspective.

The main principle of the EXIT procedure is to maintain uteroplacental circulation with neonatal anaesthesia by controlled uterine hypotonia. This enables securing the foetal airways and decompress or resect large neck and mediastinal foetal masses. The authors present their experience with use of the EXIT procedure in 7 foetuses in whom evaluation and management of the airways were performed. In 4 patients, the neck mass was surgically removed in the neonatal period, in 1 the propranolol treatment was introduced. Two newborns died shortly after the EXIT procedure. The EXIT procedure allows the paediatric otolaryngologist to provide airway patency of newborns during delivery. Both ultrasound and MR imaging are crucial in the prenatal assessment of foetal head and neck masses. Their application in the evaluation of any foetal anomaly is essential for proper prognosis and treatment. Maternal monitoring for complications such as polyhydramnios and preterm labour are important in planning and desirability of the EXIT procedure.

[C14-aminopyrine breath test and enzymatic liver tests in workers employed by the coke tar distillation department]. / Test oddechowy z C14-aminopiryna i klasyczne enzymatyczne testy watrobowe u pracowników zatrudnionych w wydziale weglopochodnych zakladów koksochemicznych.

A group of 400 subjects divided into three sub-groups was examined. Group I consisted of 130 persons employed at the coke tar distillation department. Group II (controls) consisted of 70 persons also employed at the coke plant but free from occupational exposure. Group III was composed of 200 workers employed at the Building Factory. C14-aminopyrine breath test (ABT) was performed in 30 subjects randomly assigned from each group. A standard enzymatic liver test was assessed in all subjects examined. The range of tests performed did not permit to indicate the toxic effect of occupational environment on the liver tissue. Abnormal enzymatic liver test found in all groups could results, among others, from alcohol abuse among those tested. However, it was revealed that aromatic hydrocarbons to which workers of the coke tar distillation department were exposed to, stimulated the activity of the liver microsomal oxygenase assessed by ABT.

[Frequency of chromosome aberration in workers of a coke derivative distillation plant]. / Czestosc aberracji chromosomalnych u pracowników wydzialu weglopochodnych koksowni.

The effect of occupational exposure on frequency of chromosomal aberrations in workers of coke by-product department was estimated. Fourty seven persons employed in that plant, exposed to tar substances, BaP and dust and 77 non-exposed controls were examined. Concentrations of tar substances, BaP and dust exceeded MAC 13.9, 10 and 1.5 times, respectively. The structural chromosomal aberrations were evaluated in peripheral blood lymphocytes after 72h cultivation, according to a modified Moorhead method. The findings did not revealed any significant differences in the frequency of chromosomal aberrations between the compared groups. These results seem to be produced by a relatively low level of exposure.

[The ankle-arm index and whole blood viscosity in patients with type II diabetes mellitus with ischemia of the lower extremities]. / Wskaznik kostkowo-ramieniowy a lepkosc krwi u chorych na cukrzyce typu II z choroba niedokrwienna konczyn dolnych.

The relationship was studied between the ankle-arm index (K/R) and whole blood and plasma viscosity in patients suffering from diabetes mellitus type II with ischemia of lower extremities. The measurements were carried out in 96 patients (80 males and 16 females), of whom 72 were in stage II of Fontaine progression. Immediately after determination of the K/R index blood was taken from vena mediana cubiti adding Na2EDTA for rheological test. Whole blood viscosity was measured with a Low-Shear 100 Contraves viscometer immediately after sampling, and plasma viscosity was measured with a capillary viscometer of Ubbvelohd within 2 hours after sampling. By the method of regression analysis and linear correlation it was found that increased whole blood and plasma viscosity significantly correlated with reduced K/R value in the patients. The obtained results are analysed in biophysical and clinical aspects.

[Cytoenzymatic and ultramicroscopic investigations of blood in coke oven workers]. / Badania cytoenzymatyczne i ultramikroskopowe granulocytów krwi obwodowej u pracowników zatrudnionych przy produkcji koksu.

White blood cell count, cytoenzymology (acid and alkaline phosphatase, beta-glucuronidase and myeloperoxidase of granulocytes) and ultrastructure of granulocytes and NBT reduction test were performed in peripheral blood obtained from cokery plant workers. All the subjects were divided into groups according to degree of exposure to BaP. Occupational exposure to many factors during coke production, especially to high concentration of BaP cause perceptible changes of NBT reduction test in the group more exposed workers. A statistically significant of the totally activity of the acid phosphatase and beta-glucuronidase of granulocytes were found in this risk group. The changes in granulocyte function correlated with ultrastructural changes. The coking plant environment represent a strong stimulator of the neutrophil metabolism.

[Certain complications of diabetes mellitus in old age]. / Niektóre powiklania w cukrzycy wieku podeszlego.

The incidence rate of the diabetes mellitus in the aged patients has been analyzed. The clinical picture, complications, and the treatment varieties were evaluated in 2260 patients observed in the diabetes dispensary. Among them this disease has been diagnosed in 500 patients after 60 year of life. The results of the observations were compared with that found in 160 patients with diabetes diagnosed before the 35 year of life. This analysis revealed that the insulin treatment decreases in the aged patients the retinopathy rate, that in them the hypersensitivity and the resistance against this hormone are rather exceptional.

[Pulmonary function changes as a late diabetic complications]. / Objawy plucne póznych powiklan cukrzycowych.

During diabetic process angiopathy of lung vessels may be expected. In the study authors evaluated values of spirometric and gasometric parameters in patients with diabetes mellitus in two groups--with and without diabetic complications. It was documented that diabetic process caused the decrease of pulmonary diffusion volume and some gasometric disturbances. This above mentioned spirometric and gasometric changes indicated some coexistence with a late diabetic complications.

[Characterization of coke derivate distillation departments in coke plants. Hygienic and ergonomic conditions]. / Charakterystyka dzialu destylacji weglopochodnych zakladów koksochemicznych. Warunki higieniczne i ergonomiczne.

The studies were carried out in three coke plants mostly with the use of individual dosimetric methods but also with the stationary method. They revealed the values 2-5 times exceeding the MAC of the tar substances in the air of all workposts, and benzo(a)pyrene at several posts only. The other toxic substances like benzene homologous and benzologous and dust exceeded the MAC value only incidentally so that the workers of this department were less exposed than the people employed directly at the coke production. The ergonomic examinations did not reveal any excess of energetic expenditure or physiological cost. The results of medical studies will be presented in further papers.

[Effect of working in a coke plant on levels of carbon monoxide hemoglobin in employed workers]. / Wplyw pracy w zakladach koksochemicznych na zachowanie sie hemoglobiny tlenkoweglowej u zatrudnionych pracowników.

Concentrations of carbon monoxide hemoglobin in blood of 48 furnace-room, and of 31 carbon derivatives department workers for many years exposed to carbon monoxide (divided into smokers and non-smokers) were assessed by spectrophotometry. CO levels were within the values provided in the corresponding standards for the occupational exposure, there was, however, the risk of periodically exceeding the MAC values. It has been found that HbCO levels in the workers of the furnace room and of the carbon derivatives department were much significantly higher than in the controls, both in the smoker and in the non-smoker group.

Pulmonary complications of type 1 (insulin-dependent) diabetic patients.

We have investigated the influence of diabetes mellitus including the presence of late complications of the pulmonary system. To check this relationship 31 Type 1 (insulin-dependent) diabetic patients (mean age 30.6 +/- 5.32 years, mean duration of diabetes 12.9 +/- 5.05 years) were admitted into the trial and compared with 18 control subjects. Pulmonary function tests were measured including spirometric parameters, diffusing capacity, specific diffusing capacity and dynamic compliance measured at 20 and 60 breaths per min. No disturbance of the spirometric parameters was observed in the diabetic patients. Diffusing capacity in the diabetic patients with complications was significantly lower than in both the diabetic patients without complications and the control group (81.2 +/- 16.2%, 104 +/- 13.7%, 99.3 +/- 2.8%; p < 0.001, p < 0.005 respectively). Specific diffusing capacity was significantly lower in the diabetic patients than in the control subjects (80.3 +/- 13.1% vs 89.4 +/- 12.9%; p < 0.05). In the group with late complications specific diffusing capacity was lower than in the group without complications (69.7 +/- 9.17%; 87.2 +/- 10.7%, respectively; p < 0.001). Dynamic compliance at 20 breaths per min in diabetic patients was 84.06 +/- 17.08% vs 95.2 +/- 11.59% in the control subjects (p < 0.05). It was particularly low in the group with late complications 80.6 +/- 13.2% and patients with metabolic poor control, 80.3 +/- 12.02% (both p < 0.005 vs the control group). Dynamic compliance at 60 breaths per min was 60.1 +/- 15.0% as compared to 83.2 +/- 13.3% in the control group (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical assessment of treatment results for atherosclerotic ischemia of the lower extremities with intraarterial ozone injections]. / Ocena kliniczna skutecznosci leczenia miazdzycy zarostowej konczyn dotetniczym wstrzykiwaniem ozonu.

Ten injections of O3 into femoral arteries were administered to 50 patients with atherosclerotic ischemia of the lower extremities and to 49 diabetic patients. All patients were assessed clinically with the ankle-arm index, measurement of intermittent claudication distance prior to and after the treatment. The treatment showed a significant improvement in both groups manifested by an increase in ankle-arm index, and prolongation of the intermittent claudication distance by more than twice. The treatment of atherosclerotic ischemia of the lower extremities with O3 is both valuable and safe.

[Analysis of the causes and clinical course of anemia in elderly patients]. / Analiza przyczyn i przebiegu niedokrwistosci u osób w wieku podeszlym.

Anamnesis of patients treated for anemia at the Department of Internal and Occupational Diseases in Zabrze in 1984-1988 were analysed. It was found that the incidence of anemia in patients over 60 years of age was significantly higher. Decreased function of hematopoietic system, more frequent deficits of factors indispensable for the normal erythropoiesis, i.e. iron and vitamin B12, and coexisting diseases, especially neoplasms and uremia, predispose to anemia in this age group. Anemia seen in the group of patients with diabetes mellitus type 2 was most probably a result of the chronic treatment with sulfonylurea derivatives.

[Endoscopic picture of hemorrhage from the upper digestive tract in elderly patients]. / Obraz endoskopowy krwawienia z górnego odcinka przewodu pokarmowego u osób w wieku podeszlym.

The causes of upper gastrointestinal tract bleeding were analysed in 412 patients dividing them into age groups below and over 60 years. Both groups were compared using endoscopic classification of bleedings by Forrest. In the group aged over 60 years a significantly higher per cent of type II lesion was found, especially non-bleeding vascular stump protruding from the bottom of the ulcer. This lesion was associated in nearly half the cases with recurrence of bleeding. The finding of this endoscopic picture should suggest the necessity of a more radical operation, although the operative risk is higher in patients aged over 60 years.

[Different course of myocardial infarction in old age]. / Odmiennosc przebiegu zawalu serca u ludzi w wieku podeszlym.

For the assessment of the peculiarities of acute myocardial infarction in patients aged over 60 years 100 patients with this disease treated at the Department of Internal and Occupational Diseases, Silesian Medical Academy were compared with 100 patients aged below 60 years. The location of myocardial infarction was similar in both groups. In the younger group premature ventricular beats were more frequent while in the older group supraventricular or ventricular tachycardia and left bundle branch block were more frequent. The death rate was much higher in the older group.

[Evaluation of the immune system in workers engaged in the production of coal derivatives]. / Ocena ukladu odpornosciowego u osób pracujacych przy produkcji substancji weglopochodnych.

The study involved 361 people, 161 of whom were workers of coke plants and the remaining 200 constituted the control group. The coke plant workers were divided into the exposed and non-exposed groups. All of them were subject to the following tests: rosette test, determination of B lymphocytes, determination of the concentration of IgG, IgA, IgM immunoglobulins, and NBT granulocyte reduction test only were found in group I. Subgroups Ia, IIa, IIIa were established, in which subpopulations of T, TH-helper, TS-suppressor, TH and NK (Natural Killer) lymphocytes were discovered in group Ia. The above observations can probably be associated with exposure to tar substances which contain pyrenes.

[Some hemostatic parameters after treatment with ozone in a group of patients with obliterative atherosclerosis of the lower extremities and in a group of patients with diabetes]. / Niektóre parametry hemostazy po leczeniu ozonem w grupie chorych na miazdzyce zarostowa tetnic konczyn dolnych oraz w grupie chorych na cukrzyce.

Basic hemostasis and fibrinolysis parameters have been analysed in the group of 35 patients with obliterative atherosclerosis and in 41 patients with diabetes mellitus treated with intra-arterial ozone in concentration of O2/O3 54 micrograms/cm3 O3. Assayed parameters were within normal values. However, a tendency to decreased blood coagulation following ozone therapy was more pronounced in patients with obliterative atheromatosis, than in these with diabetes mellitus.

[Ozone therapy and viscosity of blood and plasma, distance of intermittent claudication and certain biochemical components in patients with diabetes type II and ischemia of the lower extremities]. / Ozonoterapia a lepkosc krwi i osocza, dystans chromania przestankowego oraz niektóre skladniki biochemiczne krwi u chorych na cukrzyce typu II z choroba niedokrwienna konczyn dolnych.

Blood and plasma viscosity, total blood lipids, triglycerides, total cholesterol, free fatty acids, fibrinogen, hematocrit, and lipidogram were determined in patients with diabetes mellitus type II and coexisting symptoms of the obliterative arteriosclerosis of the lower limbs. Intermittent claudication distance has been measured parallel. The same tests have been carried out after ozone therapy. A significant improvement in the intermittent claudication and reduction in blood and plasma viscosity have been noted. There was statistically significant correlation between intermittent claudication decrease and blood viscosity reduction following ozone therapy.

[Ozone therapy and viscosity of blood and plasma, distance of intermittent claudication and certain biochemical plasma components in patients with occlusive arteriosclerosis of the lower limbs]. / Ozonoterapia a lepkosc krwi i osocza, dystans chromania przestankowego oraz niektóre skladniki biochemiczne osocza u chorych na miazdzyce zarostowa tetnic konczyn dolnych.

Blood and plasma viscosity, total lipids, triglycerides, total cholesterol, free fatty acids, fibrinogen, lipid-gram, and hematocrit were determined in 53 patients with occlusive arteriosclerosis in the lower limbs prior to and after ozone therapy. At the same time the distance of the intermittent claudication was measured. A significant prolongation of the distance walked painlessly, reduction in blood and plasma viscosity as well as the decrease in total cholesterol after therapy with ozone correlated with a decrease of the blood viscosity.

[Evaluation of hepatic microsomal enzyme activity using C-l4-labeled aminopyrine breath test in patients with diabetes mellitus type 2 treated with tolbutamide]. / Ocena aktywnosci enzymów mikrosomalnych watroby za pomoca testu oddechowego z zastosowaniem 14C-aminopiryny u chorych na cukrzyce typu II leczonych tolbutamidem.

Among 116 diabetic patients of the District Diabetic Polyclinic in Zabrze (51 type II treated with tolbutamide++, 36 type I treated with insulin, 29 type II treated with diet only) and 30 health persons functional microsomal hepatic fraction with ABT was assessed. Classical hepatic function test were done too. Among 49% patients under examination with type II diabetes treated with tolbutamide++ statistically significant decrease of value of ABT was observed as compared with other groups. Values of classical hepatic function tests in investigated patients were within normal values. Decrease in demethylation of aminopyrine shown as the abnormality in values of ABT can be considered as early symptom of hepatocyte damage caused by tolbutamide++. ABT is valuable method of appraising the liver's detoxication function in type II diabetes. Patients treated with tolbutamide++ should not receive any other drug known as inhibitor of microsomal enzymes of the liver.

[The course of liver cirrhosis not preceded by viral hepatitis with p articular reference to toxic etiology]. / Przebieg marskosci watroby nie poprzedzonej wirusowym zapaleniem, ze szczególnym uwzglednieniem etiologii toksycznej.

The study was aimed at analysing the epidemiological structure of patients with liver cirrhosis without HBsAg treated in 1980-1988. There were 231 of such cases in this period of time. The most frequent cause of liver cirrhosis in patients under 60 years of life was chronic alcoholism whereas 40% of the diagnosed liver cirrhosis in older persons was of unclear etiology. Patients complaints, clinical examinations, and results of the laboratory tests were analysed. The course of the disease was more severe in alcohol-produced liver cirrhosis leading to the haemorrhage from esophageal varices in 36%, and coma in 8% of cases. Alcohol-produced liver cirrhosis promoted other complications such as: cancer of the liver, hepato-renal syndrome or encephalopathy. Liver cirrhosis of unclear etiology in the elderly may be a consequence of the prolonged exposition to environmental pollutants. More severe course of alcohol-produced liver cirrhosis may depend on simultaneous action of two harmful factors: alcohol and environmental pollutants.